Application sites:

U.S. Patent: 9,707,197,B2 – Multiprofen CC™ and related products are trademarked properties of their respective owners and are used under Licenses. All rights reserved.

Why Topical?

Topical delivery systems are used to control pain and act locally on damaged or dysfunctional soft tissues or peripheral nerves. They are not absorbed through the gastrointestinal system and do not undergo first pass hepatic metabolism. Less than 5% of the dose that is topically applied reaches the systemic circulation, which further explains our clinical experience of no reported systemic side effects or drug interactions. (Osterwalder et al. Arzneim-Forsh 2002 52:822-827)

Pain signalling involves complex mechanisms. For neuropathic pain, peripheral activity of afferent nerves is an important contributor to pain. These conditions can benefit from a localized application of topical medications; combinations of agents targeting different pain mechanisms may be particularly useful. It is postulated that topical medications may play a role in desensitizing trigger zones and can reduce peripheral sensibility of areas affected by deafferentation and neuroma formation. (Safety and Efficacy of Topical Ketoprofen in Transfersome Gel in Knee Osteoarthritis: A Systematic Review. Sardana V1, Burzynski J2, Zalzal P1. 2017)

Optimal treatment may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, anti-arrhythmics, anesthetics, antiviral agents and NMDA (N-methyl-D-asparate) antagonists. NMDA-receptor antagonists such as Ketamine or Dextromethorphan can block pain transmission in the dorsal horn spinal neurons, reduce nociception, decrease tolerance to and the need for opioid analgesics (Anesth Analg 2001 Mar; 92(3): 739-44). By combining various agents which utilize different mechanisms to alter the sensation of pain, physicians have found that smaller concentrations of each medication can be used.

The American Academy of Orthopaedic Surgeons has a strong recommendation for the use of topical anti-inflammatory drugs (NSAIDs) for patients with symptomatic osteoarthritis of the knee.

Ingredients Include:

Amitriptyline

Local release of adenosine and activation of adenosine A1 receptors is involved in the action of Amitriptyline, as analgesia is reduced by adenosine receptor antagonists and local administration of Amitriptyline enhances the peripheral availability of adenosine.(Sawynok et al., Esser and Sawynok 2000)(Liu et al., 2006)

Baclofen

Baclofen is a GABA agonist myorelaxant possessing presynaptic depressant action at NMDA and non-NDMA receptors. Activation of GABAb receptors by local administration of Baclofen results in a uniform reduction in formalin-evoked behaviours (Zhou et al., 1998), and these receptors may represent a more promising target than GABAa receptors.(Pharmacol Rev 55:1-20, 2003)

Ketoprofen

Ketoprofen has anti-inflammatory activities. It is well documented through numerous trials that Ketoprofen is effective topically. The results of clinical trials proved that by applying a 100mg Ketoprofen patch daily directly to the focus of the painful condition, the concentration of Ketoprofen in the affected area was anywhere from 6 to 354 times higher than in the plasma.

Lidocaine

We will continue to help patients by working directly with physicians and patients in the triad of care to increase the efficiency of pain management with effective pain creams.

Thank you, The Multiprofen CC™ Team

U.S. Patent: 9,707,197,B2 – Multiprofen CC™ and related products are trademarked properties of their respective owners and are used under Licenses. All rights reserved.

Safety Info

Health Canada has stated that compounded prescriptions are both ethical and legal as long as they are prescribed by a licensed practitioner for a specific patient and compounded by a licensed pharmacy. Compounding is regulated by the provincial boards of pharmacy.

The Health Canada Drug Manufacturers approval process is intended for mass-produced drugs made by large manufacturers.Multiprofen CC™ is a compounded medication which is personalized for individual patients. Each ingredient in the Multiprofen CC™ family is approved by Health Canada.

Safety Instructions

For External Use Only

Do not prescribe the product if the patient had an anaphylactic reaction to ketoprofen, other non-steroidal anti-inflammatory drugs (NSAIDs), baclofen, amitriptyline, or lidocaine. Contact the pharmacy to remove the active ingredients in question.

Do not prescribe for those who are pregnant or breast-feeding.

Do not apply to skin with conditions such as open wounds or cuts, or on skin that has a rash or eczema.

Use with caution in patients with fluid retention or heart failure. Hypertension can occur with oral (tablet) NSAID treatment. Monitor blood pressure closely.

Use with caution in patients with liver and kidney failure. Monitor lab values.

Use with caution in patients on blood thinners. Monitor lab values.

As with all medications, side effects can occur, so please consult your doctor or pharmacist immediately should you experience any irregular symptoms.

U.S. Patent: 9,707,197,B2 – Multiprofen CC™ and related products are trademarked properties of their respective owners and are used under Licenses. All rights reserved.

Zalzal Trial

This is a brief report of my clinical experience using a novel multi modal topical compound (MMTC) cream. My name is Dr. Paul Zalzal, I am a Board Certified Orthopaedic Surgeon having received certification from the Royal College of Physicians and Surgeons of Canada. I hold a license to practice medicine within the Province of Ontario. I am the former Chief of the Division of Orthopaedics at the Oakville-Trafalgar Memorial Hospital and an Assistant Clinical Professor in the Department of Surgery, Faculty of Medicine at the McMaster University. I have post-graduate training in Orthopaedic Sub-specialties including Foot and Ankle Reconstruction, adult Hip and Knee Reconstruction and Revision Arthroplasty. I have research interests in lower extremity trauma, hip and knee reconstruction, biomechanics and tissue engineering. I have several peer review publications in these areas. I have a Master’s Degree in Biomedical Engineering from the University of Toronto.

I have been prescribing Multiprofen CC™ in my clinical practice to assist with the management of patients with various musculoskeletal conditions. I prescribe Multiprofen CC™ for patients to control pain and inflammation due to soft tissue trauma, arthritis, post-operative pain and chronic pain. I prescribe the topical cream to be used on various body parts including, the neck, back, shoulders, arms, wrists, hips, knees and ankles. In general, the clinical situations where I have found Multiprofen CC™ useful include patients who are waiting a long time for surgery as a result of long waiting lists. It is useful in patients for whom surgery is contraindicated (advanced age, poor health etc). I have used it in the setting of acute pain following injury or exacerbation of underlying arthritis. It is effective in the management of post-operative pain and chronic pain. It is also useful in the management of post-operative stiffness after total knee replacement by enabling more aggressive physiotherapy.

I surveyed over 60 consecutive patients who were using Multiprofen CC™ to determine if they experienced any pain relief, and if so what percentage of pain relief they experienced. My results showed that 80% of the patients surveyed experienced some form of relief. Of those who experienced relief, the average pain relief they reported was 67%. The only side effect reported was a rash in 3 % of the patients surveyed. The rash resolved when they discontinued use.